Combatting Native American Health Disparities by Engaging Communities

The University of Rochester Medical Center Office for Inclusion and Culture Development will host Shaela Maybee, B.S., health planner and grant coordinator for the Seneca Nation Health System, as part of its diversity seminar series. Maybee will discuss the importance of community health assessments in identifying unique needs of communities and the holistic approach of the ‘Good Health and Wellness in Indian Country’ grant in addressing health disparities in Seneca Nation communities.

The Good Health and Wellness in Indian Country grant, awarded to the Seneca Nation of Indians in March of 2015, provides five years of funding from the Centers for Disease Control and Prevention (CDC) to assess community health and develop programs to combat health disparities in Indian country. Under the grant, health indicators such as tobacco use, second hand smoke exposure, exercise, healthy diet, breastfeeding, and community supports are assessed.

According to Maybee, before she and her team could even look at the grant, they took several steps to ensure they engaged the community in their research. They started by engaging key directors within the Seneca Nation and holding Community Health Assessment Workshops (CHAW’s)  to demonstrate the importance of administering a health assessment survey. Key informant interviews and focus groups were conducted to get community input about which issues they thought should be addressed in the survey.

These are steps that Maybee says are often neglected. “People often make programs for others to follow and they never get the blessing, feedback, or any sort of input from the community,” she said.

That lack of community consultation is often compounded with a lack of communication about study results. This leaves the community feeling overburdened with surveys, which often ask many of the same questions, and they never see a benefit – no programs are developed, no policies changed.

Maybee believes that engaging the community up front and throughout the research process will boost the study’s accountability in the eyes of the community.  This is critical for establishing sustainable programs that address health related concerns outlined by the community.  

Maybee is currently using this model to assess breastfeeding habits and barriers in Indian Country. The latest and most reliable (though imperfect) data suggests that breastfeeding rates in the Seneca Nation are about half that of NYS.  Out of all Seneca Nation children enrolled in the Women, Infants, Children program, which covers children ages 0 – 5 years old, 15 percent were breastfed in recent reports.

Though these rates may have been skewed by inconsistencies in survey questions at different time points and they do not represent a full picture of children who have ever been breastfed, they offer a glimpse at a possible health disparity in the Seneca Nation. In a subsequent community health assessment, Maybee identified four major barriers to breastfeeding with “returning to work or school” topping the list.

Maybee and her team are revising how data are collected to improve accuracy and gain a fuller picture of breastfeeding among Seneca Nation communities. They hope these changes will help them detect when breastfeeding drops off.

“If there is a lot of correlation at 6 weeks or 8 weeks when a mom would be assumingly going back to work, it could really help promote new policies to give women time to breastfeed either at work or at their child care facility,” says Maybee.

She and her team are working to develop breastfeeding policies and programs that launch in January, 2017. They want an overarching policy that covers more women and children than current policies, which only apply to Seneca Nation employees who enroll their children in the Seneca Nation's daycare. They also plan to add breastfeeding support to current prenatal programs providing breast pumps, prenatal education, and access to certified lactation consultants.

While Maybee hopes these policy changes can buoy the breastfeeding rate, she warns that some issues are more deeply rooted than most policies can touch. For instance, in the Mohawk Nation, low breastfeeding rates were linked to grandparents’ desire to participate in child rearing.

“It's these cultural and historical types of things that could be affecting our health that we have to look at,” said Maybee. “What we are seeing today may have been established long ago in a history of trauma.”

Maybee will discuss these issues further in a diversity seminar on Friday, November 18, 12:00 - 1:00 pm in Helen Wood Hall 1W-501. To register, contact Grace Fuller. 

Michael Hazard | 11/3/2016

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